Healthcare Provider Details

I. General information

NPI: 1740429836
Provider Name (Legal Business Name): INTERNATIONAL CONSULTING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 N ELSTON AVE STE 103
CHICAGO IL
60642-2449
US

IV. Provider business mailing address

1467 N ELSTON AVE STE 103
CHICAGO IL
60642-2449
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-3600
  • Fax: 312-943-3096
Mailing address:
  • Phone: 312-943-3600
  • Fax: 312-943-3096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number203000284
License Number StateIL

VIII. Authorized Official

Name: MS. IWONA KORZENIOWSKA
Title or Position: PRESIDENT
Credential: PT
Phone: 312-943-3600